Solutions to Four Common Foot Problems

One surprise of aging: Your tootsies can feel the worse for wear. Here's how to deal with bunions, heel inflammation, hardening skin and nail fungus

by Emily Listfield

Photograph: Illustrated by Thomas Fuchs

Take a break from activities that irritate the nerve, such as anything that entails pounding the balls of your feet. For instance, if you are a gym-goer, use an elliptical trainer rather than a treadmill; replace a step class with Pilates. If pain continues, a cortisone injection can offer temporary relief by calming the nerve. It is not a cure, though, and repeated injections are not recommended because they can lead to nerve atrophy.

What a surgeon can do: The last resort for neuromas is surgery that removes the irritated nerve tissue, which entails up to three weeks of recovery. There is a risk of scarring, which can be painful, and full recovery can take up to three months. “I recommend trying more conservative treatments for six months first,” Deland says.

Causes: Some 10 percent of American adults (more men than women) have this condition, which is sky-high in the yuckiness factor. You inherit a susceptibility to the fungal infection, which can enter in a spot where the nail is split or at an opening on the edge of the nail bed. Older, thicker nails are more at risk, according to the Mayo Clinic.

What you can do at home: Drugstore aisles are rife with OTC topical antifungal products, and they can work, though treatment may take up to a year as the damaged nail grows out. Baravarian offers this tip: “To help medication penetrate, file the top of your nail to remove the shiny coating.”

The most efficacious treatment is the prescription drug Lamisil (terbinafine), taken orally for three (or more) months. “About 75 to 88 percent of cases get cleared up, but the drug has serious side effects,” says Youner. “Three percent of patients experience an elevation in liver enzymes.” To monitor your levels, Baravarian recommends you get a blood test before you start treatment with Lamisil and another a month later.

Fungi breed in moist environments, so to speed recovery and avoid re-infection (always a possibility), choose shoes made of natural, breathable fibers (as opposed to, say, rubber), with enough room for your toes to spread. Also, wear cotton socks and change them if they become damp. Youner recommends going without polish on your toes as much as possible. “Let your nails breathe,” she says.

What a laser can do: In 2010 the Food and Drug Administration approved the Pinpointe Laser to treat toenail fungus. Youner is among those who have incorporated the Pinpointe into her practice. “We do it in a surgical center, no general anesthesia required. The laser goes through the nail and vaporizes the fungal material beneath it. In my experience, most people need a boost about six months later,” she says. A small, independent study published in the Journal of American Podiatric Medicine found that 85 percent of patients who received laser treatment experienced mild to moderate improvement after 180 days. The cost can be up to $1,200 per treatment and is generally not covered by insurance.